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PPI-clopidogrel co-prescribing 'has no effect on mortality'

By Lilian Anekwe

The largest systematic review of interactions between proton pump inhibitors and clopidogrel has concluded that co-prescribing the two drugs does not increase mortality in patients at risk of heart attacks and strokes.

Recent studies have suggested that patients receiving clopidogrel will not get the full effect of the treatment if they are also taking PPIs, and that the combination of the two may increase patients' risk of stroke, heart attacks and death.

Researchers from the University of Anglia analysed data from 23 randomised controlled trials of more than 90,000 patients worldwide. A meta-analysis of 13 studies showed a non-significant association between co-prescribing and mortality.

Dr Yoon Loke, clinical senior lecturer at the University of East Anglia who led the study concluded: ‘Our findings showed no evidence of any effect on overall mortality and no associated risk with the co-prescribing of these agents.

‘It is therefore premature to impose a blanket policy of withdrawal or avoidance of PPI use in patients taking clopidogrel. Clinicians should instead re-focus on a patient's susceptibility to gastric bleeding and not lose sight of the fact that some patients with high gastrointestinal risk may genuinely benefit from PPI therapy.'

Aliment Pharamacol Ther 31, 810-823

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